Primer on Redundant Communications

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					       Primer on
Redundant Communications



     Recommendations of the
        State Expert Panel
       on Communications




          February 2007


Wisconsin Division of Public Health
Hospital Emergency Preparedness
                             Table of Contents
Primer on Redundant Communications…………………………………….…...page 3

Tier 1: Landline and Cellular Telephones……………….....……………………page 4

Tier 2: Two-Way VHF/UHF/800MHz Radio……… ……..…………………… page 8

Tier 3: Satellite Telephone …………………………………………………..… page 11

Tier 4: Amateur (HAM) Radio…...……………………………..………..………page 13

Exercising Telecommunications Redundancy ………………………………….page 14

Recommendation 47…………………………………...………………………….page 14

Appendix A: Sample ARES Emergency Communication Hospital Plan…..…page 16

Appendix B: A True Story – February 2007…………………………………….page 18

Appendix C: Worksheet A – Critical Functions and Telecommunications
Capability………………………………………………….……………………….page 20

Appendix D: Example – Critical Functions and Telecommunications
Capability……………………………………………………………………….….page 21

Appendix E: Example of a Count Communications Interoperability Plan……page 22
Primer on Redundant Communications
The Office of the Assistant Secretary of Preparedness and Response (ASPR), formerly Health
Resources and Services Administration (HRSA) and Centers for Disease Control (CDC)
Preparedness Cooperative Agreements have required that hospitals and public health
departments have communications redundancy so that should one communications system fail to
function, there are other technologies that can be implemented to maintain communications
among emergency responders.

To provide recommendations for hospitals and public health departments regarding
telecommunications technology, the Wisconsin Division of Public Health, Hospital Emergency
Preparedness Program, established the State Expert Panel on Communications. The Panel was
composed of representatives from hospitals, public health departments, EMS, Emergency
Management, State Patrol, law enforcement, National Guard, telecommunications companies,
amateur (HAM) radio, fire departments, and 911 Dispatch.

The work of this Expert Panel resulted in the recommendation that each hospital and public
health department in the State of Wisconsin have four tiers of communications redundancy:

        •      Landline/Cellular Telephones
        •      Two-Way Radio (UHF/VHF/800mhz)
        •      Satellite Telephone
        •      Amateur (HAM) Radio

To support these four tiers of communications redundancy and to assist hospitals and public
health departments in the implementation of these four tiers of communications, the Expert Panel
offered 46 recommendations for consideration.

Note: These recommendations represent the consensus of the Expert Panel. They were
developed for the State of Wisconsin. All recommendations may not apply to all states and even
regions within various states.

In late 2006 the state Hospital Emergency Preparedness Program identified certain
recommendations that were required of all hospitals if they received federal preparedness funds
for the purchase and/or implementation of telecommunications technology. These “required
recommendations” are in BOLD print.

Baseline Recommendations

The recommendations, offered by the Expert Panel, are “baseline” recommendations. Baseline
refers to the fact that these recommendations will help hospitals and public health departments
establish a foundation of telecommunications technologies. Baseline also refers to the fact that
these recommendations are intended to evolve over time as these organizations learn more about
these four levels of redundancy and how they can be further enhanced.



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The Expert Panel also recognized that the availability of communications technology and staff
with communications expertise varies at hospitals and public health departments. Some of these
recommendations can easily be implemented because of IT staff availability and expertise; other
organizations will find it difficult to implement even some of the most basic recommendations.

Each hospital and public health department should adapt these recommendations to their unique
environment. Not all recommendations are meant to be implemented equally across all
organizations. There is also more than one way to implement each recommendation. Each
organization will also need to consider the operational and financial impact of these various
recommendations as they develop their plans.

Tier 1: Landline and Cellular Telephones
Landline-dependent telecommunications technologies include (not inclusive):

         •     Analog and Digital Telephones (corded and cordless)
         •     FAX Machines
         •     Landline Telephone Calls to Cellular Telephones
         •     Cellular Telephone Calls to Landline Telephones
         •     Dial-Up and DSL1 Internet
         •     Dial-Up and DSL Email
         •     Voice Over IP2 via Dial-Up or DSL
         •     T13 (or higher) Lines


Why do landline circuits get overloaded? The landline system is typically built for 18%
capacity. The assumption is that, at any given moment, 18 or less of every 100 users are on the
telephone. Circuits were well over capacity in New York City on 9/11. Events such as Mother’s
Day (busiest calling day of the year) and snow storms (everyone is calling home before leaving
work) can overload circuits.

T1 (or higher) Lines: These are dedicated landline circuits and are used, especially by hospitals
and public health departments, for dedicated data access. These lines are more likely to get
overloaded at the “server” or beyond, when many users are trying to access certain web sites
such as the state Health Alert Network. Since these lines are dedicated circuits, they are not
shared outside the organization. They can become inoperable due to damage, but overload can be
prevented by an internal usage policy. T1 lines allow for 24 talk paths (48 users); some of these

1
  A digital subscriber line (DSL) connection is a very high-speed connection that uses the same wires as a regular
telephone line.
2
  Voice over Internet Protocol, also called VoIP, IP Telephony, Internet telephony, Broadband telephony, Broadband
Phone and Voice over Broadband is the routing of voice conversations over the Internet or through any other
Internet Protocol (IP) based network.
3
  If you have a T1 line, it means that the telephone company has brought in a fiber optic line (a T1 line might also
come in on copper). A T1 line can carry 24 digitized voice channels or 48 paths (your call going out and the other
call coming in) or it can carry data at a rate of 1.544 megabits per second. If the T1 line is being used for telephone
conversations, it plugs into the telephone system. If it is carrying data, it plugs into the network's router.


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paths can be used for access to the Internet, while other paths can be used for voice
communication.

Cellular Telephones to Landline Telephones: If landlines circuits are open and operational, a
cellular telephone call to a landline telephone (or vice versa) is connected. If landline circuits are
busy or down, then cellular telephone calls to landline telephones or vice versa may not go
through because the cellular telephone is using part of the 18% landline capacity.

Cellular Telephone to Cellular Telephone: If landlines are down, cellular telephones may still
call cellular telephones, assuming communication towers are functional. Cellular telephones are
also typically built for 18% capacity. When capacity is reached, the cellular circuits are
overloaded. Extended power outages can exhaust back-up power supply at cellular towers and
cause cellular telephones to fail.

Note: Technologically, “Blackberries” and other similar devices are the same as cellular
telephones.

With this introduction to landline and cellular phone technology, the Expert Panel made the
following recommendations.

Note: Required recommendations are in BOLD print.

1.      All hospitals and public health departments must to identify personnel that fulfill
        critical functions and determine what communications technology these critical
        functions must have available.

        Note: Appendix C “Worksheet A – Critical Functions and Telecommunications
        Capability”, on page 20 can be used to identify critical functions and what
        telecommunications technology should be available for each critical function. Appendix
        D is an example of a completed worksheet and can be found on page 21.

2.      All hospitals and public health departments must have landline telephone capability for
        critical functions.

3.      All hospitals and public health departments must have FAX machine capability for
        critical functions.

4.      All hospitals and public health departments must have cellular telephone capability for
        critical functions.

5.      All hospitals and public health departments must have a T1 (or greater) lines for
        high speed access to the Internet.

6.      All hospitals and public health departments must have partial use of a T1 Line for voice
        communication.




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7.        All hospitals and public health departments must have an internal policy to manage
          use of T1 lines, when there is the potential for staff to overload these circuits.

8.        All hospitals and public health departments must have email capability for critical
          functions.

9.        All hospitals and public health departments must have Internet access for critical
          functions.

10.       All hospitals and public health departments must have dedicated telephone lines
          (POTS4) for critical function areas.

          Note: Dedicated telephone lines are defined here as a unique line that goes from a
          specific telephone within the organization to the outside by-passing the organization’s
          telephone system.

11.       Each dedicated line must include the telephone number clearly marked on the
          instrument along with instructions on how to dial.

          Note: Sine the dedicated line bypasses the organization’s telephone system, a person
          unfamiliar with the dedicated line may attempt to dial “8” or “9” in an attempt to make
          the call and be unable to complete the call.

12.       If using a cordless telephone for critical functions, all hospitals and public health
          departments should have emergency power/battery backup. If unable to have
          emergency power/battery backup, a corded phone may work best in this situation.

Power Outage: Most landline and cellular telephone companies have emergency power backup.
Remember any cordless telephone will need a battery backup in order to be used in a power
outage (the base station needs electrical power to operate).

13.       All hospitals and public health departments that use cable for Internet must have
          discussions with their cable provider about what back-up systems are available.

Cable Internet: Cable Internet is dependent upon electrical power and can be damaged
physically. However, Cable Internet can continue to be accessed even if landlines are down or
overloaded, provided there is electrical power.

Email and Internet: Dial-Up and DSL Email and Internet depend upon landlines and are subject
to overload and physical damage.



4
    POTS stands for “Plain Old Telephone System”. Non-POTS lines are based on high-speed, digital
communications lines, such as ISDN (integrated services digital network) and FDDI (fiber distribute data
interface). The main distinctions between POTS and non-POTS services are speed and bandwidth. POTS
is generally restricted to about 52 kbps (52,000) bits per second or “dial-up speed”).


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Satellite Internet: Satellite Internet is also dependent upon electrical power. The satellite dish
can be physically damaged, interfered with by sun/weather or be susceptible to landline
problems. However, Satellite Internet can continue to be accessed even if landlines are down or
circuits are overloaded, provided there is electrical power.

14.     The Expert Panel does not recommend Satellite Internet Service as a redundancy for
        Internet access.

Physical Damage: Besides being overloaded, cellular telephones, landlines and T1 lines can be
damaged physically, e.g. “digging in your garden”, “blowing up the switching station”
intentionally, such as by a terrorist attack, “blowing up the switching station” unintentionally,
such as by a tornado or a backhoe accident.

15.     All hospitals and public health departments are to have GETS access for critical
        functions.

G E T S: “Government Emergency Telecommunications Service” provides emergency access
and priority processing. A dial-tone is needed to access GETS. GETS is not just for long
distance, but is also extremely useful for local congestion and damage. On September 11th,
18,000 GETS calls worldwide were made with a 95% completion rate.

How GETS Works: 1) You call the GETS toll free number and enter your PIN 2) GETS
(transparent to you) connects you to a nationwide carrier like Sprint or AT&T (alternate numbers
are also available if these are not your long distance carriers)

Cost for GETS: There is no activation or monthly fee; however, there is usage fee. The usage
fee is $0.075 or $0.10 per minute (dependent upon your carrier). A GETS account must be
established.

16.     All hospitals and public health departments should have WPS access for critical functions.

W P S: “Wireless Priority Service” is the wireless complement to GETS. Currently, WPS is
available in Wisconsin through AT&T Mobile, Nextel and T-Mobile. Sprint and Verizon are also
scheduled for WPS. This service must be added to the cell phone.

How WPS Works: Calls are queued for the next available radio channel by dialing *272 plus
the destination number. If landline networks are congested, dialing *272 + GETS toll free
number will give the caller priority on both the wireless and landline networks.

Cost for WPS: There is a $10 activation fee, a $4.50 monthly fee (This is a cap only; the actual
fee may be less dependent upon the carrier) and a $0.75/minute airtime charge. The use of WPS
does not count against cellular plan minutes.

17.     All hospitals and public health departments should consult with their local
        telephone company about repair priority. Depending upon the established priority,
        the hospital or health department may consider getting TSP.



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T S P: “Telecommunications Service Priority” mandates that telephone companies prioritize
service requests for TSP subscribers. There is an annual cost associated with this service.
Telephone companies usually work with local authorities to prioritize repairs.

What technologies does the telephone company use for redundancy? They use exactly what
the Expert Panel is also recommending for hospitals and public health departments: cellular
telephones, two-way VHF/UHF radio, satellite telephones, Amateur (HAM) radio.

Tier 2: Two-Way VHF/UHF/800MHz Radio
Understanding Radio Communications: “If you understand two tin cans and a string, then you
understand radio communications”. There is one receiving and one transmitting unit. The signal
is sent over the airwaves (the string). Only one person can talk at one time. The limitations of
communicating using two tin cans and a string are also the same limitations of two-way radio.

What Is Radio Communication?: Radio provides the ability to talk over the airwaves: Simplex:
one radio unit communicates with another radio unit on a single frequency; Duplex: multiple
radio units can communicate with multiple radio units through a “repeater” system, using two
frequencies (listen and transmit frequencies are simultaneous). A “repeater”: a tower that picks
up a signal from a radio and transmits it to another radio.

What Bands Are Used?: VHF, UHF, 800 MHz, 900 MHz (cellular telephones), Microwave

Who Uses Two-Way Radio: Radio is mostly used by Public Safety: Law Enforcement, Fire
Departments, Hospitals, Emergency Medical Services, Emergency Management, Public Health,
Government, Businesses (such as utilities).

Who Can Use Which Frequencies?: In the State of Wisconsin, for example, each Public Safety
discipline is pre-assigned a specific frequency. For example: 155.475 is assigned to Law
Enforcement; 154.295 is assigned to Fire Services; 155.340 is assigned to EMS.

What Is a Trunking System?: A trunking system is a digital system (computer operated). Think
of a line in a bank: all people stand in one line and then you go to the first teller available. A
trunking system pools all frequencies and makes the line that first becomes open, available to the
first user (system is transparent to the user).

Advantages of Radio: Radio allows for a large number of users, the ability to communicate with
many other users at once (broadcast capability). Radio has inexpensive upfront costs and
minimal recurring costs. It is easy to operate (push-to-talk), independent of other communication
systems and fairly easy to learn.

Disadvantages of Radio: You cannot “ring” someone (some systems now have this capability).
The range is limited by power, terrain and system design. Battery life is also limited for hand-
held radios. There are a limited number of frequencies and talk groups (radio frequencies are



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shared). There is the high potential for unauthorized use of and access to frequencies.
Communication is not secure (encryption requires additional equipment).

Interoperability: The definition of interoperability is the ability of various groups to talk with
one another by radio. It requires a plan to know on which frequencies they will communicate and
what equipment will enable this communication on these frequencies. This plan needs to deal
with obstacles to communication (terrain, power, etc.).

There are very few, if any, interoperability problems with a telephone. You simply pick up any
telephone, anywhere, dial the number and you can communicate. Interoperability is not that easy
with radios. Radio users choose one or more of the multiple bands with different frequencies
available and with different equipment available. This creates many problems for users in
communicating with one another.

Users have different radio systems. One system works well in one location but not in another.
There are different protocols and frequency bands. Oftentimes, there is the lack of knowledge of
who has what frequencies. There are also political and “turf” issues.

Project 25: Project 25 (P25) is the standard for interoperable digital two-way wireless
communication products and systems, developed by state, local and federal governments and the
Telecommunications Industry Association (TIA). P25 is accepted as the standard for public
safety, security, public service and commercial applications. P25 standards are not required for
EMS and hospital base stations (unless equipment is being purchased with Homeland Security
funds). Other public safety agencies do not need to upgrade to P25 for the next 5 – 10 years.
There will be no negative effect upon State EMS and hospital communications as others become
P25 compliant. The cost for P25 equipment is 2 - 3X greater.

Internal Radios: Radios can be used within a hospital or health department so that staff can
communicate with one another and also with others outside the facility such as law enforcement.
If the hospital or public health department emergency communications plan includes
communications with law enforcement, the radio must be capable of transmitting on law
enforcement frequencies -- with permission!

“Narrow Band” Project: This is a project that is already underway. It is the ability to create
more frequencies by “narrowing” the band. All radio equipment must be narrow band
operational by CY 2013. For example:

      •   155.340 (existing band)
      •   “155.3475” (created by narrowing the band)
      •   155.355 (existing band)

Statutory Requirements: Hospitals and public health departments should know the statutory
requirements for two-way radio in their state. For example, in the State of Wisconsin, EMS and
hospitals are required to obtain an FCC5 license for operation of a two way radio base station.

5
    FCC is the Federal Communications Commission


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18.     All hospitals are required to have the ability to communicate on the State EMS
        channel so ambulances from any area can make contact with the hospital.

19.     All hospitals must have UHF/VHF two-way radio communication with EMS.

20.     All hospitals must have radio communications with local EMS, if different from
        VHF.

21.     All radio licenses must be current and up-to-date.

22.     Any new radio equipment purchased by hospitals and public health departments must
        support statewide interoperability and have access to statewide frequencies.

23.     Any new radio equipment purchased by hospitals and public health departments
        needs to be narrow band capable.

24.     Each hospital and health department must have an Interoperability Plan for its home
        county.

        Note: Appendix E: “Example of a County Interoperability Plan” is on page 24. The intent
        of the plan is to have each emergency responder list the frequencies that they use and
        then for other emergency responders to determine with whom they need to communicate
        and on which frequencies and then to determine if their equipment will permit them to
        communicate on those frequencies.

25.     Each hospital and health department should have an Interoperability Plan for its collar
        counties.

        Note: The emergency responders should do the same process described in #24 for their
        collar counties if applicable.

26.     Any new equipment purchased by hospitals and public health departments should have
        the capability to communicate on all channels identified by the Interoperability Plan.

27.     Each hospital is encouraged to have an additional multi-channel radio to communicate on
        ALS and EMS Coordination channels. A) This additional radio must also have scanning
        capability. B) This additional radio must have access to 155.280 for inter-hospital
        communications.

28.     Each hospital and health department must have internal radios so that critical
        functions can communicate with one another and with others outside the facility (if
        necessary).




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29.     If internal radios are used to communicate with others outside the facility, there
        must be authorization to use their channel and also agreement on which channel to
        use.

Tier 3: Satellite Telephone
Why Satellite Telephones: Landline circuits can get overloaded or damaged. Cellular
telephones do not work everywhere. Radios do not work everywhere. Amateur (HAM) radios:
you are usually dependent, due to FCC regulations, upon a non-staff person to operate the
Amateur (HAM) radio.

How Does the Satellite Telephone Work?: A satellite telephone can call another satellite
telephone. 1) The call signal goes from one satellite telephone to the satellite 2) The signal then
goes from the satellite to a ground station. 3) The signal goes from the ground station back to the
satellite. 4) Then the signal is sent to the satellite telephone that is being called.

A satellite telephone can also call a landline telephone. 1) The call signal goes from the satellite
telephone to the satellite. 2) The signal then goes from the satellite to a ground station. 3) The
ground station then connects your call to the landline network.

30.     Hospitals and public health department sneed to have a fixed satellite telephone. (In
        the State of Wisconsin, hospitals and public health departments were encouraged to buy a
        specific brand of satellite telephone because this brand offered the following benefits:

            •   This satellite telephone is widely used by Wisconsin Emergency Management and
                by many emergency response agencies throughout the country.
            •   This satellite telephone allows calls to be made anywhere in the United States and
                throughout most of the world without any coverage gaps.
            •   This satellite telephone provider has LEO (Low Earth Orbit – 853 miles up) base
                stations (48) in outer space so the calls are not affected by hurricanes,
                earthquakes, landline or cellular overloads.
            •   This satellite telephone allows the user to call any other brand of satellite
                telephone or any other type of telephone, pager, cellular phone, etc.
            •   This satellite telephone provider system is built for 14% capacity.
            •   The user can connect up to six extensions (using corded or cordless telephones) to
                the satellite telephone; a cordless telephone allows the user to be mobile.
                However, it must be remembered that there is only one line. For example, a
                hospital could have a satellite telephone extension in the Command Center,
                Emergency Department, Medical Director’s Office, Security Department, Plant
                Operations, and Nursing Director’s Office.
            •   With this satellite telephone there is no “rain fade” effect.
            •   With this satellite telephone there is no voice/signal delay (“as seen on CNN”).
            •   This satellite telephone allows for voice ail (The user can access voice mail
                simply by dialing the satellite telephone number from any telephone anywhere,
                inclusive of the satellite telephone. There is no cost for accessing voice mail.)
            •   This satellite telephone allows the user to send and receive email.


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            •   This satellite telephone allows for the transmission of data and documents. (The
                user can connect the computer to the satellite telephone and can transmit data and
                documents through the computer as per usual.) The satellite telephone can
                transmit at “dial-up speed”: a 10K document is transmitted in 10 seconds (1
                minute of air time usage); a 100K file in 100 seconds (1.6 minutes of air time
                usage); a 1,000K file in 1,000 seconds (16.6 minutes of air time usage).
            •   The satellite telephone has multiple call plans similar to a cellular telephone. (If
                hospital or health department has more than one satellite telephone line, all
                minutes can be pooled).
            •   The satellite telephone provider is also an Internet Service Provider (ISP) and its
                Internet service is independent of the ISP of the hospital or the health department
                (users must establish a separate email address, e.g. “gmail”, “hotmail”, etc.).
           •
        Note: The features and benefits listed above are only to provide a guide for a user when
        considering various vendors.

Is the Satellite Telephone Call Secure? It is very difficult to intercept a satellite telephone call.
All calls from the satellite telephone are encrypted. The weakest link is from the ground station
to the landline or cellular telephone being called or from the personal computer to the satellite
telephone (these are the same weak links in normal day-to-day communications).

31.     All hospitals and public health departments need to have a fixed satellite telephone,
        capable of transmitting voice, email and data.

32.     All hospitals and public health departments should have satellite telephone capability for
        critical functions.

33.     All satellite telephone extensions should be cordless telephones with battery-back-up
        for portability.

34.     All satellite telephones should also have connectivity to the computers in the critical
        function areas so that they can email and access the Internet.

35.     All hospitals and public health departments need to have a protocol to test the
        satellite telephone and its various functions (voice, email, data transmission) at least
        quarterly.

What About Hand-Held Satellite Telephones? Hand-held units have limited utility. Obviously,
it must be used outside and in areas where there are no obstructions 10 degrees above the
horizon. At times, the user may be faced with inclement weather conditions. An antenna may be
used and mounted to the outside of a vehicle allowing the user to stay inside the vehicle during
inclement weather.




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Tier 4: Amateur (HAM) Radio
Many people think of HAM radio as a large metal box with all kinds of glowing tubes (that was
yesteryear). Today a HAM radio can be as small as a credit card.

Who Uses HAM Radio? HAM is a free radio service, authorized by the FCC and utilized by
licensed operators. HAM radio is used by these operators to assist in emergency situations.
Amateur Radio Emergency Service (ARES) and Radio Amateur Communications Emergency
Services (RACES) consist of licensed amateurs, who have voluntarily registered their
qualifications and equipment for communications duty when a disaster strikes.

How Far Can HAM Radio Reach? A small five watt radio can transmit up to 15 miles. Using a
repeater, the same radio can transmit up to 100 miles. Using shortwave radio frequencies, HAM
radios can transmit anywhere in the world.

How Does HAM Radio Work in an Emergency? Hospitals and public health departments have
been encouraged to have a Memorandum of Understanding (MOU) with an ARES/RACES team.
The ARES/RACES team provides the hospital and the health department with an operator to
assist the facility with communications. The ARES/RACES operator operates the radio; the
facility controls the communication messages. Some hospitals and public health departments
have an antenna fixed and available for the ARES/RACES operator. If there is no available
antenna, the ARES/RACES operator will provide the temporary infrastructure.

HAM radio can serve multiple purposes within a hospital or health department. The most
obvious function is for HAM radio to be used to communicate with emergency responders
outside the hospital. Another very valuable use is for HAM radio to serve as a proxy for the
hospital telephone system, should that system become dysfunctional. In this case HAM operators
at various locations can communicate with one another much like a PBX telephone system.

Note: Appendix A: “Sample of an ARES Emergency Communications Hospital Plan” can be
found on page 16.

Can an Employee Operate a HAM Radio? No, the ARES/RACES operator must operate the
HAM radio. However, if an employee has a HAM radio license, they may operate the radio even
if radio operations are not part of their daily job responsibilities.

36.     Each hospital and health department must include HAM radio as part of their
        redundant communications plan.

37.     Each hospital and health department must have a Memorandum of Understanding
        with the ARES/RACES team to provide HAM radio services, when requested, in an
        emergency.

38.     Each hospital and health department must provide orientation to any new HAM
        operator regarding their responsibilities in an emergency.



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39.     Each hospital and health department needs to involve the Ham radio operator in at least
        one exercise annually.

40.     Each hospital and health department should have a pre-designated area in which the
        HAM operator will work.

41.     Each hospital and health department should have a fixed antenna and power supply
        available to the HAM operator (if applicable).

42.     Each hospital and health department should consider having someone with a HAM radio
        license on staff.

Exercising Telecommunications Redundancy
Funding from ASPR and CDC Preparedness Cooperative Agreements will help hospitals and
public health departments to enhance their telecommunications CAPACITY (equipment). Since
the CAPABILITY (ability and proficiency) of hospitals and public health departments to know
who, where, how and when to use these communications technologies comes only through
EXERCISE, the Expert Panel made the following recommendations:

43.     All hospitals and public health departments need to include use of redundant
        communications in each exercise (as appropriate).

44.     All hospitals and public health departments need to ensure that critical functions exercise
        the use of communication technologies assigned to them.

45.     All hospitals and public health departments should involve their emergency response
        partners, at least annually, in a test of the redundant communication systems.

46.     All hospitals and public health departments should hold an exercise of their four tiers of
        communications redundancy without commercial electrical power.

“Recommendation 47”
The Expert Panel recognized that it was not possible to address every telecommunications
recommendation to fit the unique situation of individual hospitals and public health departments.
“Recommendation 47” is for each hospital and health department to complete a
telecommunications needs assessment to determine what telecommunications technologies and
set-up is needed for its unique situation.




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For questions regarding this document, please contact:

   Dennis Tomczyk
   Director, Hospital Emergency Preparedness Program
   Wisconsin Division of Public Health
   608-266-3128
   dennis.tomczyk@dhs.wisconsin.gov




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Appendix A:
Sample ARES Emergency Communications Hospital Plan

                                    St. Camillus Hospital
                                        Ozone County
                               Emergency Communications Plan6
In the event that a communications casualty occurs at St Camillus Hospital (SCH)
requiring OZARES7, the following plan will be activated. Upon notification by SCH, Ozone
County Emergency Management will activate OZARES. A resource net will be established
using 147.330 and available personnel will be directed to report to the Ambulance Bay at
SCH.

      1] The first OZARES member to arrive at SCH will go to the Emergency Desk and
         contact the Emergency Room Supervisor or the House Supervisor to determine the
         nature of the communications assistance required.

      2] Get the tote with radio equipment from the storage room at the east end of the
         Ambulance Bay. The Emergency Department Supervisor or Hospital Security (ext. 797)
         can open the room. The combinations for the case locks are 5555 and 6666.

      3] Set-up the external antenna that is stored in the SW corner of the bay. It is to be
         erected in the existing pipe located between the driveway and sidewalk, about 15 feet
         west of the west entry door. The coaxial cable from the antenna connects to a cable box
         adjacent to the vehicle entry door, above door level.

      4] Set-up the radio equipment on the counter at the east end of the EMT room. Check
         in on the resource net (147.330). At this time activate the 800 MHz trunk radio located in
         the cabinet above the counter. The trunk radio will provide coverage for the SCH and
         Ozone County Emergency Management talk groups.

      5] Initially establish a tactical net using OZARES TAC 1 (146.400). The net will provide
         communications between Net Control and the following locations:
                        Incident Command
                        Triage
                        Surgery
                        ICU (Intensive Care Unit)
                        Supply
         These locations may be changed and personnel reassigned by the Incident Commander or
         the Emergency Room Supervisor if designated by the Incident Commander.




6
    This is an actual plan. The names and telephone numbers are fictitious.
7
    OZARES is the ARES Emergency Management Coordinator in Ozone County


Page 16 of 22                                                                    Version Date 1/9/2009
    6] When a mobile unit capable of operating as a crossband repeater is available, it
       should be set up on the eastern edge of the east parking lot adjacent to Main Street.
       OZARES CBR1 will be the designated primary circuit. After the mobile unit has been
       placed and satisfactory operation verified, Net Control will direct all stations to shift
       operations over to CBR1, Primary.

    7] Two persons should be assigned to the Net Control position. They may provide
       breaks for each other on an hourly basis or sooner as operations permit. Net control
       operators should be relieved on a two-hour schedule.

    8] All operators should be relieved on a four hour schedule if replacements are available
       or they should be rotated between stations.


                                   Frequency Plan
OZARES CBR One            OZARES CBR Two         Primary Simplex       Secondary Simplex
HT Transmit – 2M          HT Receive – 2M        OZARES TAC 1          OZARES TAC 2
   146.490 pl 100.0          147.555 pl 100.0        146.400               146.580
HT Receive – 70cm         HT Transmit – 70cm
   441.425 pl 100.0          446.425 pl 1000.
Mobile Receive – 2M       Mobile Transmit – 2M
   146.490 pl 100.0          147.555 pl 100.0
Mobile Transmit – 70cm    Mobile Receive 70cm




Page 17 of 22                                                                   Version Date 1/9/2009
Appendix B:
A True Story - February 2007
I don't know how many of you were affected by the cutting of the fiber cable on Sunday, but we
were. I received the call a little before 6 am to tell me the cell phones and long distance was out.
The staff had noticed the cell phones out of service about 1:30 am but didn't need them or need
to make a long distance call until just before calling me at 6:00 am.

I checked out incoming T1 circuits and all seemed OK, but thought I would contact our long
distance/circuit manager, Norlight Communications. I was surprised to find even the 800
numbers wouldn't work. No problem, I pulled out the satellite phone and went to dial, NO
DIALTONE. I couldn’t believe it, but it was dead also. I couldn't imagine there would be a
relationship between a satellite device and a landline outage, but sure enough it seemed to be.

My next option was to fire up the amateur HAM radio and see if I could get to someone outside
of the affected area. I got right through to a HAM friend not too far away, but one that had the
ability to make an 800 call. I had them relay the information to Norlight Service to get a ticket
started for me. He came back while the tech was on the line and told me there had been a major
fiber line cut somewhere between Baraboo and Madison or near Madison and everything this
direction was out.

Apparently it is a major backbone as many areas were affected. I could dial local to our own
prefix, but not to other local areas. He couldn't dial out long distance other than the 800 number
so I made a contact with someone further out that had all their services and they were going to
just stand by in case I needed a messaging service. I let the nurses’ stations know that if they
needed to make a long distance call for an emergency to contact me in the Emergency
Communication Center and at what extension and I would get it out of the building. Fortunately
we did not have any emergencies that needed to have phone calls made but we could have gotten
them through.

We got our satellite service back about 10:30 am and all services were restored by 2:30 pm.
They had to do some rerouting and splicing around the site but managed to get everything up and
going. I closed up the ECC by 2:45 pm. On Monday I called our Regional ASPR Coordinator
for a satellite telephone contact to find out what was going on and was somewhat relieved to hear
that their outage had nothing to do with the cut fiber. It was coincidental but they are in the
process of relocating some satellites to make room for a couple new ones and said we will
experience some periodic outages until they are done in May. It just happened to be at the same
time as the other outage. What are the chances of that happening?

The bottom line is, if you have not met with your local amateur radio people to get your
communication system up and going, it is a really good thing to do. It was our only means of
communication out of our town for several hours on Sunday. I now have applied for the second
go around of grant money to enhance the system to add packet data equipment to also be able to
send emails direct from the amateur setup also. We will have the ability to set one up to cross
band and then use a handheld at the nurses’ stations on low power to repeat the signal out at a



Page 18 of 22                                                                     Version Date 1/9/2009
higher power on the big antenna to message from a remote location while still having the other
system for email or voice as needed.

We have requested some of the new Motorola 900 MHz digital radios for our in-house
communications. If you haven't tried them they are unbelievable in their coverage. They
covered easily our entire grounds and as far as a couple blocks away and the fact that they are
digital, they are crystal clear in their voice quality. They have many options like group call
which is the ability to call every radio that is turned on, only a specific group (maintenance, for
instance) or even a private call to a specific radio without anyone else hearing anything. They
are limited in that they can't be used to contact with outside agencies, but for us they are going to
work great.

I know we all are struggling with the time and funds needed for someone to manage this
redundant communications requirement, but I certainly am not going to look a gift horse in the
mouth and will put in for all I can get. I have seen the results of the efforts so far and I say it
works.




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Appendix C:
Worksheet A - Critical Functions and Telecommunications Capability

This blank worksheet is available for you to use as a planning tool as you consider what telecommunications equipment.
Please remember that these are telecommunications modalities that should be available to these Critical Functions in a
disaster situation and not necessarily for day-to day communications.


                                                                                             Satellite                  Satellite
                                 Cellular         Internet                        Internal               Dedicated
 Critical Functions   Landline              FAX              Email GETS WPS                  Internet                    Phone
                                  Phone           Access                           Radio                   Line
                                                                                               Jack                    Extension
CEO/Administrator

 Medical Director
    Emergency
    Department
Incident Command

 Plant Operations

 Nursing Director

      Security




Page 20 of 22                                                                                             Version Date 1/9/2009
Appendix D:
Example - Critical Functions and Telecommunications Capability
The following is only an example and is not meant to be a representation of the critical functions of what telecommunications
modalities each critical function should have available. This planning tool is very important for helping you to determine what
telecommunications equipment is necessary for which critical functions. Please remember that these are telecommunications
modalities that should be available to these critical functions in a disaster situation and not necessarily for day-to day communications.


                                                                                                      Satellite                  Satellite
                                    Cellular           Internet                           Internal                Dedicated
 Critical Functions     Landline               FAX                Email GETS WPS                      Internet                    Phone
                                     Phone             Access                              Radio                    Line
                                                                                                        Jack                    Extension
CEO/Administrator           X          X        X         X        X        X                X           X                          X

 Medical Director           X          X                  X        X        X                            X                          X
    Emergency
                            X                    X        X                 X                X           X           X              X
    Department
Incident Command            X          X        X         X        X        X                X           X           X              X

 Plant Operations           X                                               X                X           X                          X

 Nursing Director           X          X                           X        X                            X                          X

      Security              X          X                                    X                X           X                          X




Page 21 of 22                                                                                                      Version Date 1/9/2009
Appendix E:
Example of a County Communications Interoperability Plan




                                                                                                                                                               White SO 1

                                                                                                                                                                            White SO 2
                                                                                                                           State EMS

                                                                                                                                       State ALS
                                                 WISPERN




                                                                                                                 FIRECOM
                                                                                   WISTAC1

                                                                                             WISTAC2

                                                                                                       WISTAC3




                                                                                                                                                   WEM Car
                                                                   MARC1

                                                                           MARC2
                       White County




                                                           POINT
                     Emergency Responders
                Albany EMS                                 Y       Y                                                       Y           Y                       Y            Y
                Albany Fire                                                Y       Y                             Y         Y           Y           Y           Y            Y
                Albany Police                    Y         Y       Y       Y                                                                                   Y            Y
                Rochester Fire                                     Y       Y                                     Y         Y           Y                       Y            Y
                Rochester Police                 Y         Y       Y       Y                                     Y         Y           Y           Y           Y            Y
                White County Public Works
                White County Highway Dept.                 Y                                                     Y         Y                       Y
                White County Sheriff             Y         Y       Y       Y       Y         Y         Y         Y         Y                                   Y            Y
                White County Health Department
                Memphis Fire                                       Y       Y                                     Y         Y                                   Y            Y
                St. Helen Hospital                                                                                         Y
                Montana Police                   Y         Y       Y       Y                                                                                   Y            Y
                Montana Streets                                                                                                                                Y            Y
                Montana Waste Water                                                                                                                            Y            Y
                Montana Water Utility                                                                                                                          Y            Y
                Boulder Police                   Y         Y       Y               Y                             Y         Y                       Y           Y            Y
                Boulder Public Works
                New Madrid EMS                   Y         Y       Y       Y                                     Y         Y           Y                       Y            Y
                New Madrid Fire                                    Y       Y                                     Y         Y           Y                       Y            Y




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